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Once formed, habits are difficult to break. It always just seems easier to go on as you have before. This can become a serious problem when science gets in the way of the habits. If you look at the world of adverts in print and the media, you will see opioids recommended as the sure-fire drugs to use as painkillers, no matter what the pain. It carries on in the venerable tradition of the slogan, “Beecham’s Pills cure all ills”. The idea of a panacea – one pill to rule them all, as The Dark Lord of Mordor might have said – has been around since the beginning of time. This is fair game for the marketers to use when talking to the public, but the same thinking has entered the training manuals for the medical profession. Sit in lectures for student doctors and you will hear the same story that opioids are the first line of defense when it comes to moderate to severe pain. Once you have the source of the prescriptions in on the group think, the habit is almost impossible to break.

The monitoring and review process put in place after a drug is released into the market is designed to catch any unexpected side effects. If evidence of problems emerges, the FDA can require the manufacturer to change the warnings on the label or, in the worst cases, withdraw the drug from the market. But this monitoring process is not designed to catch the drugs that are ineffective. If no-one has an adverse reaction when taking it, no report is filed with the FDA. It’s safe so who cares whether it works. All this brings us to the Cochrane Collaboration. This is a non-profit group where researchers sift through and analyze existing published medical research to see whether there are any consistent patterns – what might not be apparent in one clinical trial involving two hundred participants might be identified when you compile the results from fifteen different trials, each involving two hundred participants. Two recently published Cochrane Reports have concluded that opioids should not be routinely prescribed to patients even with severe pain from hip and knee osteoarthritis.

In both Reports, the independent conclusions were that the adverse side effects outweighed the benefits and that tramadol, as the leading opioid, was no more effective than the strongest NSAIDs. The first Report consolidated the results from ten trials involving a total of just over 2,250 participants and concluded that there was little pain relief and minimal improvement in mobility. With higher dosages, one in twelve participants experienced adverse side effects. The second Report consolidated the results from eleven trials involving 1,020 participants and found little difference between the effectiveness of tramadol and the placebo. This leads to a somewhat controversial conclusion. That doctors should not routinely prescribe opioids for the treatment of hip and knee osteoarthritis. There should be a careful discussion of treatment options including weight loss, physical therapy and exercise, and a detailed explanation of all the adverse side effects to be expected. This new research does not change the general acceptance of tramadol as an effective painkiller. All it does is confirm that there is no such thing as one pill to cure all ills.

The health story that had everyone’s attention at the beginning of the year was the threat of swine flu (quickly renamed H1N1 flu to avoid damaging the market for the sale of pork products). We all watched as the threat level inched up to pandemic. The number of people dying was like watching the latest lottery numbers to see how many lost. Yet, although millions of people have caught this flu, only a few tens of thousand have died. Our attention shifted elsewhere. But there is still interesting news about the pattern of deaths. The people most likely to die are young and, almost without exception, they are obese. Frankly, if you carry excess weight, this flu is a killer, which raises a more general question for you to chew on. No matter what you might choose to believe, the majority of people are overweight because of their lifestyles. They eat too much and exercise too little. So, the US is a country where individual liberty is the most important quality of life. It’s up to every one of us to take personal responsibility for what we do and the consequences of those actions. So what personal responsibility should we take for our own health? Further, if we are against big government, should people who do not take care of their health just be allowed to die if they do not have enough money to pay for health insurance?

The latest statistics show that, as a nation, we spend about 16% of the gross domestic product on health care. This includes the cost of medications and is double the average in countries around the world. But we are not a healthy nation. Counting the number of prescriptions fulfilled through real world pharmacies, we consume more sleeping pills and antidepressants per head of population than any other nation. That’s before we start guessing how many drugs are purchased on the internet. We are seriously overmedicated. The results are easy to see. Many drugs cause insomnia as an unintended side effect. So we all walk around like zombies and beg our doctors for relief. So now comes the difficult decision. Do you reduce the dosages of the drugs you are taking, or add ambien to the mixture to offset the side effects? The rational answer is to do without the first drug altogether. If it is interfering with your sleep and making you feel worse, you should stop taking it. Adding a second drug to balance out the side effects of the first is more expensive and potentially going to make you dependent on one or both drugs.

When there is very clear scientific evidence showing meditation and relaxation techniques as a completely effective treatment for insomnia, there should never be a need to take sleeping pills. People should go through the simple training program and emerge better able to control their sleep patterns. As a result, their general health will improve. But, as with everything, there are problems. The marketers have managed to convince the majority of us that drugs are the best form of treatment. We are taught to dismiss psychology as a waste of time. Worse, private health insurance often will not pay for the training sessions. At a time of recession, this leaves many with no choice. There is only enough to buy ambien and not enough to pay for training in something we do not trust.